Title: Changing trends in epidemiology of type 1 diabetes mellitus throughout the world: How far have we come and where do we go from here

1Changing trends in epidemiology of type 1 diabetes mellitus throughout the world How far have we come and where do we go from here

Ingrid Libman, M.D., Ph.D.

Ronald LaPorte, Ph.D.

University of Pittsburgh

2Objectives

Counting diabetes Historical background

Diabetes Registries What have we learned?

Challenges ahead Where do we go from here?

3Objectives

Counting diabetes Historical background

Diabetes Registries What have we learned?

Challenges ahead Where do we go from here?

4Need to count disease, specifically diabetes, started a long time ago.. 5Counting diabetes Why is it important?PreventionReducing the incidence of disease (primary prevention) Reducing the prevalence of disease (secondary prevention)ControlOngoing operations or programs aimed at reducing the incidence and/or prevalence of diseaseLast, Dictionary of Epidemiology 6Counting diabetesdiarrhea of the urine .. the thirsty disease rare .only seen two cases..Galen, disciple of Hippocrates Second century AD 7.Diabetes is a wonderful affection, not very frequent among men, being a melting down of the flesh and limbs into urine the patient is short-lived if the constitution of the disease be completely established Aretaeus the Cappadocian Disciple of Hippocrates Second century AD 8diabetes seldom seen in cold Europe and frequently encountered in warm Africa have not seen in the West here, in Egypt, in the course of 10 years, I have seen more than twenty people who suffer this illness.Maimonides 1135-1204 AD 9Historical backgroundEnd of 1970s

11It took many centuries.Book summarizing contributions, clinical and population-based on the subject of diabetes epidemiology and highlighted the many gaps in our diabetes epidemiology knowledge at that timeKelly West, 1978 "Epidemiology of Diabetes and its Vascular Complications" 12A survey of twenty diabetologists revealed that they employ diagnostic criteria differing quite substantially. In some populations, including the general population of the United States, these disparities would result in very major differences in the rates of "diabetes." Under certain common circumstances, some diabetologists would classify as normal more than half of the one- and two-hour values considered to be abnormal by other well-qualified diabetologists Substantial differences in the diagnostic criteria used by diabetes experts KW West Diabetes 1975 13Historical background1979 1980

22One of the fundamental necessities of cancer surveillance is for users of cancer information to be assured that case definitions, data collection, is standardized. This enables compilation of case-specific information into useful and meaningful registers. It also enables meaningful comparison of data across different registries North American Association of Central Cancer Registries 23IDDM Registries Eligibility Criteria

Xthe epidemiologists challenge 40Diabetes in ChildhoodEfforts such as DIAMOND and EURODIAB should continue

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